Psoriatic Arthritis Drug Summary

Last updated: 19 November 2025
Reviewed by

Corticosteroid Hormones

Drug Dosage Remarks
Betamethasone 1.5-12 mg IA depending on the size of the affected joint Adverse Reactions
  • Charcot-like arthropathy, post-injection flare, injection site atrophy
Special Instructions
  • Contraindicated in patients with hypersensitivity, active untreated infections
Dexamethasone 0.8-4 mg IA depending on the size of the affected joint
Hydrocortisone 5-50 mg IA depending on the size of the affected joint
Methylprednisolone Small joints: 4-10 mg IA
Medium joints (elbow, wrist): 10-40 mg IA
Large joints (knee, ankle):
20-80 mg IA
Repeat doses are not usually required for 1-5 weeks
Triamcinolone acetonide Small joints
Initial dose: 2.5-5 mg IA
Max dose: 10 mg
Large joints
Initial dose: 5-15 mg IA
Max dose: 40 mg

Disease-Modifying Anti-Rheumatic Drugs (DMARDs)

Drug Dosage Remarks
Abatacept Loading dose
<60 kg: 500 mg IV infusion over 30 minutes 24 hourly
≥60-≤100 kg: 750 mg IV infusion over 30 minutes 24 hourly
>100 kg: 1 g IV infusion over 30 minutes 24 hourly
Repeat at 2 and 4 weeks after first infusion then every 4 weeks thereafter
or
125 mg SC weekly		 Adverse Reactions
  • CNS effects (dizziness, headache, fatigue, depression, anxiety, paresthesia, vertigo); CV effects (hyper-/hypotension, flushing, arrhythmias); GI effects (nausea, dyspepsia, mouth ulcers, diarrhea); Respiratory effects (exacerbation of chronic obstructive pulmonary disease [COPD], wheezing, dyspnea, nasopharyngitis, cough, bronchitis); Hematologic effects (leukopenia, thrombocytopenia); Other effects (viral reactivation, abnormal liver function tests [LFTs], injection site reactions)
Special Instructions
  • Contraindicated in patients with severe and uncontrolled infections, concomitant use with TNF inhibitors and biologic immunosuppressive agents
  • Use with caution in patients with history of recurrent infections, COPD
  • Screening for viral hepatitis and tuberculosis should be done prior to therapy
  • Monitor complete blood count (CBC), LFTs, creatinine before initiation of treatment
  • Monitor for signs and symptoms of infection
Leflunomide Loading dose: 100 mg 24 hourly PO x 3 days
Maintenance dose: 10-20 mg PO 24 hourly		 Adverse Reactions
  • GI effects (abdominal pain, diarrhea, nausea/vomiting); Hematologic effects (thrombocytopenia, eosinophilia, leukopenia, pancytopenia); CNS effects (headache, dizziness, anorexia, weakness, paresthesia); Respiratory effects (bronchitis, pharyngitis, rhinitis, sinusitis); Musculoskeletal effects (arthralgia, joint disorder, leg cramps, synovitis, tenosynovitis); GU effect (urinary tract infection [UTI]); Other effects (rash, alopecia, dry skin, eczema, pruritus, hypokalemia, weight loss, hypertension, oral thrush, stomatitis, anaphylaxis)
Special Instructions
  • Contraindicated in patients with severe hepatic impairment, compromised immune function, hypersensitivity (bone marrow dysplasia or severe uncontrolled infection), concurrent vaccination with live vaccines
  • Avoid alcohol consumption
  • Use with caution in patients with hepatic or renal impairment
  • Use with caution in women of childbearing years
  • Monitor CBC, liver function and BP regularly
Methotrexate 7.5-25 mg PO/IM/IV once weekly Adverse Reactions
  • GI effects (diarrhea, GI discomfort, ulceration of the mouth, stomatitis); Musculoskeletal effects (arthralgia, soft tissue and bone necrosis); Hematologic effects (bone marrow depression, megaloblastic anemia); Other effects (skin reactions, alopecia, ocular irritation, osteoporosis, precipitation of diabetes, anaphylaxis, impaired fertility, interstitial lung disease)
  • Hepatotoxicity and nephrotoxicity, if used long-term
Special Instructions
  • Contraindicated in patients with severe renal or hepatic impairment, pre-existing profound bone marrow suppression, alcoholic liver disease, AIDS, pre-existing blood dyscrasias
  • Use with caution in patients with hepatic or renal dysfunction, bone marrow depression, elderly, ulcerative disorders of the GI tract
  • FDA warning: Patients should be closely monitored for bone marrow, liver, lung and kidney toxicities. Patients should be informed of the risks involved and should be under a physician’s care throughout therapy
Sulfasalazine Initial dose: 500 mg PO 24 hourly x 1 week, then dose is increased to 500 mg 12 hourly every week thereafter
Max dose:
3 g/day in 2-4 divided doses		 Adverse Reactions
  • GI effects (anorexia, nausea/vomiting, diarrhea, abdominal pain); GU effects (crystalluria, reversible oligospermia); CNS effects (headache, photosensitivity); Other effects (yellow-orange staining of contact lens, skin, urine and other body fluids, alopecia, blood dyscrasia, hypersensitivity reactions, hepatic and renal toxicity, fibrosing alveolitis)
Special Instructions
  • Contraindicated in patients with intestinal or urinary obstruction, blood dyscrasias, history of leukopenia with gold therapy
  • Use with caution in patients with hepatic or renal dysfunction, G6PD deficiency, allergic bronchial asthma

Immunosuppressants

Drug Dosage Remarks
Interleukin-12/23 (IL-12/23) Inhibitor
Ustekinumab ≤100 kg: 45 mg SC on week 0 and 4 then every 12 weeks
>100 kg: 90 mg SC on week 0 and 4 then every 12 weeks		 Adverse Reactions
  • Respiratory effects (URTI, sinusitis, nasopharyngitis, oropharyngeal pain); GI effects (nausea/vomiting, diarrhea); CNS effects (headache, dizziness); Musculoskeletal effects (arthralgia, back pain, myalgia); Other effects (injection site pain or erythema, fatigue, pruritus)
Special Instructions
  • Contraindicated in patients with serious hypersensitivity to Ustekinumab, active infections (eg tuberculosis), concurrent administration of live vaccines
  • Use with caution in patients with history of chronic or recurrent infections, renal and hepatic impairment, elderly, history of malignancy
  • Monitor for the emergence of malignancies during therapy
  • Perform tuberculosis screening prior to starting therapy; continue to monitor for signs and symptoms of infection during and after therapy
Interleukin-17 (IL-17) Inhibitors
Bimekizumab 160 mg SC every 4 weeks
With concomitant moderate to severe plaque psoriasis:
320 mg SC at week 0, 4, 8, 12 and 16, then every 8 weeks thereafter
≥120 kg: 320 mg SC every 4 weeks after week 16		 Adverse Reactions
  • Dermatologic effects (tinea infections, acne, folliculitis); Other effects (headache, URTI, gastroenteritis, fatigue, injection site reactions, herpes simplex infections, oral candidiasis, other candida infections)
  • May increase risk of infections
Special Instructions
  • Regular assessment of efficacy is recommended after 16 weeks; consider a switch to 160 mg every 4 weeks if sufficient clinical response in joints cannot be maintained
  • Avoid use in patients with active TB or IBD
    • Initiate TB treatment before Bimekizumab therapy in patients with a past history of latent or active TB in whom an adequate course of treatment cannot be confirmed
  • Test liver enzymes, alkaline phosphatase and bilirubin at baseline and according to routine patient management
  • Complete all recommended age-appropriate vaccinations
  • Monitor for signs and symptoms of infection and worsening of depression, suicidal ideation or other mood changes
Ixekizumab Initial dose: 160 mg SC (given as 2 injections of 80 mg) at week 0 followed by
Maintenance dose: 80 mg SC every 4 weeks		 Adverse Reactions
  • Respiratory effects (URTI, oropharyngeal pain); Other effects (injection site reactions, herpes simplex, nausea, tinea infection)
Special Instructions
  • Contraindicated in patients with serious hypersensitivity to Ixekizumab, active infections (eg tuberculosis)
  • Use with caution in patients with history of chronic or recurrent infections
  • Perform tuberculosis screening prior to starting therapy; continue to monitor for signs and symptoms of infection during and after therapy
Secukinumab Initial dose: 150 mg SC on week 0, 1, 2, 3 and 4
Maintenance dose: 150 mg SC monthly
May be increased to 300 mg SC monthly
With concomitant moderate to severe plaque psoriasis or anti-TNFα inadequate responder
Initial dose: 300 mg SC (given as 2 injections of 150 mg) on week 0, 1, 2, 3 and 4
Maintenance dose: 300 mg SC (given as 2 injections of 150 mg) monthly		 Adverse Reactions
  • Respiratory effects (respiratory tract infections, rhinorrhea); GI effects (diarrhea, nausea); Other effects (oral herpes, tinea pedis, headache, fatigue)
Special Instructions
  • Contraindicated in patients with serious hypersensitivity to Secukinumab, active infections (eg tuberculosis), concurrent vaccination with live vaccines
  • Use with caution in patients with history of chronic or recurrent infections
  • Perform tuberculosis screening prior to starting therapy; continue to monitor for signs and symptoms of infection during and after therapy
Interleukin-23 (IL-23) Inhibitors
Guselkumab Initial dose: 100 mg SC on week 0 and 4
Maintenance dose: 100 mg SC every 8 weeks
May consider 100 mg SC every 4 weeks in patients at high risk for joint damage		 Adverse Reactions
  • Respiratory effect (respiratory tract infections); Other effects (infections, increased transaminases, headache, diarrhea, arthralgia, injection site reactions)
Special Instructions
  • Contraindicated in patients with active infections (eg tuberculosis)
  • Use with caution in patients with history of chronic or recurrent infections
  • Perform tuberculosis screening prior to starting therapy; continue to monitor for signs and symptoms of infection during and after therapy
  • Perform LFTs at baseline
Risankizumab (Risankizumab-rzaa) 150 mg SC on week 0, 4 and every 12 weeks thereafter Adverse Reactions
  • CNS effect (headache); Other effects (URTIs, fatigue, tinea infections, injection site reactions)
Special Instructions
  • Screen for tuberculosis prior to treatment initiation
  • Avoid in patients with clinically active infection
  • Avoid concomitant use of live vaccines
Janus Kinase (JAK) Inhibitors
Tofacitinib Immediate-release tab:
5 mg PO 12 hourly
Extended-release tab:
11 mg PO 24 hourly		 Adverse Reactions
  • Respiratory effects (URTI, cough, nasopharyngitis, pneumonia, tuberculosis, dyspnea, sinus congestion); GI effects (diarrhea, abdominal pain, dyspepsia, nausea/vomiting, gastritis); Dermatologic effects (cellulitis, erythema, rash, pruritus); Hematologic effects (neutropenia, anemia); Other effects (UTI, herpes zoster infection, increased liver enzymes, lipid profile elevations, hypertension, headache, fatigue)
Special Instructions
  • Use with caution in patients with active infections, increased risk for GI perforations, lymphomas and other malignancies, severe hepatic impairment, high risk of thromboembolic events
  • Perform viral hepatitis and tuberculosis screening prior to starting therapy; continue to monitor for signs and symptoms of infection during and after therapy
  • Monitor for the emergence of malignancies during therapy
Upadacitinib 15 mg PO 24 hourly Adverse Reactions
  • Respiratory effects (URTI, cough, tuberculosis); GI effects (nausea, GI upset); Hematologic effects (neutropenia, anemia); Other effects (infections including opportunistic forms, lipid profile elevations, fever, weight gain, increased CPK, ALT and AST levels, malignancy, thrombosis)
Special Instructions
  • Use with caution in patients with history of serious or opportunistic infections, risk factors for CV disorders, lymphoma and other malignancies, high risk of thromboembolic events
  • Use in patients with severe hepatic impairment is not recommended
  • Screen patients for tuberculosis, viral hepatitis and monitor for reactivation prior to initiation
  • Perform periodic skin exam in patients at increased risk of skin cancer
Phosphodiesterase-4 (PDE-4) Inhibitor
Apremilast Day 1: 10 mg PO in the morning
Day 2: 10 mg PO 12 hourly
Day 3: 10 mg PO in the morning,
20 mg PO in the evening
Day 4: 20 mg PO 12 hourly
Day 5: 20 mg PO in the morning,
30 mg PO in the evening
Maintenance dose:
30 mg PO 12 hourly starting on day 6		 Adverse Reactions
  • GI effects (diarrhea, nausea/vomiting); Neuropsychiatric effects (mood changes, suicidal ideation and behavior, depression); Endocrine/metabolic effect (weight loss); CNS effect (headache); Respiratory effect (URTI)
Special Instructions
  • Use with caution in patients taking medications which may lead to hypotension or volume depletion, with history of depression and/or suicidal behavior, renal impairment, elderly (≥65 years old)
  • Monitor weight regularly
Tumor Necrosis Factor (TNF) Inhibitors
Adalimumab (Adalimumab-afzb) 40 mg SC as a single dose every other week Adverse Reactions
  • GI effects (abdominal pain, diarrhea, constipation, nausea/vomiting, dyspepsia, esophagitis, gastritis, dysphagia, taste disturbance, mouth ulcers); Respiratory effects (URTI, cough, sore throat, asthma, dyspnea, sinusitis); CNS effects (headache, drowsiness, dizziness, agitation, tremor, insomnia, paresthesia, neuralgia, asthenia); CV effects (hypertension, chest pain); Musculoskeletal effects (arthralgia, myalgia, flu-like syndrome, back pain); Endocrine/metabolic effects (hyperlipidemia, hypercholesterolemia, hypokalemia, hyperuricemia, menorrhagia); GU effects (urinary frequency, UTI, proteinuria, hematuria); Other effects (rash, injection site reactions, ecchymosis, eye disorders, alopecia, sweating, increased alkaline phosphatase)
Special Instructions
  • Contraindicated in patients with active tuberculosis or other severe infections (eg sepsis, opportunistic infections), moderate to severe heart failure
  • Use with caution in patients predisposed to infection, heart failure, demyelinating CNS disorders
  • Monitor hemoglobin or hematocrit for signs of anemia
  • Monitor for the emergence of malignancies during therapy with TNF inhibitors
  • Perform tuberculosis and hepatitis B screening prior to starting therapy with Adalimumab; continue to monitor for signs and symptoms of infection during and after therapy
Certolizumab pegol Loading dose:
400 mg SC (given as 2 SC injections of 200 mg on thigh or abdomen) on week 0, 2 and 4
Maintenance dose:
200 mg SC every 2 weeks or
400 mg SC every 4 weeks if clinical response is confirmed		 Adverse Reactions
  • Hematologic effects (leukopenia, eosinophilic disorders); CNS effects (headache, sensory abnormalities); Dermatologic effects (rash, pruritus); Other effects (bacterial and viral infections, hypertension, hepatitis, asthenia, pain, pyrexia, injection site reactions)
Special Instructions
  • Same as Adalimumab
Etanercept 25 mg SC 2x weekly
or
50 mg SC once weekly		 Adverse Reactions
  • Respiratory effect (URTI); CNS effects (headache, dizziness); GI effects (abdominal pain, nausea/vomiting); Hematologic effects (pancytopenia, aplastic anemia); Other effects (local injection site reaction, pruritus, autoantibody formation, discoid lupus, infections, fever)
Special Instructions
  • Same as Adalimumab
Golimumab 50 mg SC once monthly
or
2 mg/kg IV infusion over 30 minutes at week 0 and 4, then every 8 weeks thereafter		 Adverse Reactions
  • Respiratory effects (URTI, bronchitis, sinusitis); CV effect (hypertension); CNS effects (dizziness, fever, paresthesia); GI effects (constipation, increased liver enzymes); Other effects (local injection reactions, viral or fungal infection, antibody formation)
Special Instructions
  • Same as Adalimumab
Infliximab Initial dose: 5 mg/kg IV infusion over a period of 2 hours at 0, 2 and 6 weeks
Maintenance dose:
5 mg/kg IV every 8 weeks		 Adverse Reactions
  • CNS effects (headache, fatigue, pain, fever); GI effects (nausea, diarrhea, abdominal pain); Respiratory effect (URTI); Musculoskeletal effects (arthralgia, back pain); GU effect (UTI); Other effects (infusion reactions, abscess formation, autoantibody formation, rash, pruritus)
Special Instructions
  • Same as Adalimumab

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Drug Dosage Remarks
Acetic Acid Derivatives
Acemetacin 90 mg PO 12-24 hourly Adverse Reactions
  • GI effects (including risk of GI bleeding and ulcers, nausea/vomiting); Hematologic effects (anemia, inhibition of platelet aggregation); CV effects (peripheral edema, fluid retention); CNS effects (dizziness, headache, nervousness); Dermatologic effects (rashes such as toxic epidermal necrolysis and Stevens-Johnson syndrome); Other effects (tinnitus, hypersensitivity reactions, hepatic dysfunction, nephropathy)
  • Use has been associated with increased risk of CV thrombotic events, including fatal MI and CVA. Risk may be increased with duration of use or pre-existing CV risk factors or disease
Special Instructions
  • Contraindicated in patients with heart failure, severe hepatic impairment, peptic ulceration, CV bleeding disorders, hypersensitivity to NSAIDs including those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by any NSAID
  • Use with caution in patients with hypertension, renal or hepatic impairment; history of GI disease (eg bleeding or ulcers)
Diclofenac
(Diclofenac potassium,
Diclofenac sodium)		 75-150 mg/day PO in divided doses
For patients unable to take oral doses:
75-150 mg/day suppository administered rectally or
75 mg IM 12-24 hourly
Etodolac 200-400 mg PO 6-8 hourly
Max dose: 1 g/day
Indometacin
(Indomethacin)		 Initial dose: 25-50 mg PO 8-12 hourly
May increase dose by 25-50 mg/day at weekly intervals
Max dose: 150-200 mg/day
For relief of morning stiffness and night pain:
100 mg PO or suppository rectally at bedtime
Max dose: 200 mg/day (combined oral and rectal doses)
Reduce dose or stop intake once pain subsides
Sulindac 100-200 mg PO 12 hourly
May lower dose based on response
Max dose: 400 mg/day
Tolmetin Initial dose: 400 mg PO 8 hourly
Maintenance dose: 600-1,800 mg/day PO in divided doses
Max dose: 1,800 mg/day
Coxibs
Celecoxib Initial dose: 400 mg PO once followed by 200 mg PO if necessary on first day
Maintenance dose: 200 mg PO 12 hourly or 400 mg PO 24 hourly
Etoricoxib Initial dose: 60-90 mg PO 24 hourly
Maintenance dose: 60 mg PO 24 hourly
Fenamic Acid Derivative
Mefenamic acid Initial dose: 500 mg PO
Maintenance dose: 250 mg PO 6 hourly
Oxicam Derivatives
Lornoxicam 8-16 mg/day PO divided 8-12 hourly
Meloxicam 7.5-15 mg PO 24 hourly
Max dose: 15 mg/day
Piroxicam Initial dose: 40 mg PO 24 hourly or in divided doses x 2 days
Maintenance dose: 20 mg PO 24 hourly x 1-2 weeks
Tenoxicam 20 mg PO 24 hourly
Maintenance dose: 10 mg PO 24 hourly
Propionic Acid Derivatives
Fenbufen 900 mg/day PO given as 450 mg PO in the morning and 450 mg PO in the evening or 300 mg PO in the morning and 600 mg PO in the evening
Ibuprofen1 1,200-1,800 mg/day PO in divided doses
Maintenance dose: 600-1,800 mg/day PO in divided doses
May increase dose as required
Max dose: 2.4 g/day
Ketoprofen 25-50 mg PO 6-8 hourly
Max dose: 300 mg/day
For patients unable to take oral doses: 100 mg to be administered rectally as suppository 12-24 hourly
Loxoprofen 60 mg PO 8 hourly or 60-120 mg PO 24 hourly
Naproxen Initial dose: 500 mg PO
Maintenance dose: 250 mg PO 6-8 hourly
Max dose: 1 g/day
Salicylic Acid and Derivative
Diflunisal Initial dose: 0.5-1 g PO
Maintenance dose: 250-500 mg PO 8-12 hourly
Max dose: 1.5 g/day
Other NSAIDs
Nabumetone 1 g PO as a single dose at bedtime
Additional 0.5-1 g may be added as a morning dose in severe cases
Nimesulide 100 mg PO 12 hourly
1Preparations containing Ibuprofen and Paracetamol are available. Please see the latest MIMS for specific formulations and prescribing information.

Disclaimer

All dosage recommendations are for non-pregnant and non-breastfeeding women, and non-elderly adults with normal renal and hepatic function unless otherwise stated.  
Not all products are available or approved for above use in all countries.  
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.   
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.

Related MIMS Drugs